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The Sexecutioner writes "WebMD is reporting on a new vaccine which has had an incredible effect in clinical trials. The vaccine, composed of human dendrites holding dead HIV viruses, has dropped test patients' viral load by up to 90% in one year. Could this be it?"

While I am glad that we may have found the cure to HIV that kills millions every year, I wonder if the vaccine will be affordable to those unfortunate ones?

I got a feeling that only those wealthy people can afford to get fixed up, but most of them caught HIV due to their irresponsible action. Yet innocent victims who caught the disease, for instance by birth, may never see the light.

It seems like most medical findings are "open-source", that you can read about them in journals, but the actual cost to produce a medicine is usually very prohibitive.

... now all you need is a "machine" to combine them! Think about the possibility of a drug which, after injected, ties itself to the dendritic cells and starts hunting in your blood for dead viruses, then replaces itself with the dead virus body -- hey, you've just produced a vaccine!

The bottom line is that now that the positive effect is demonstrated, the next step is to find out the cost-effective way to combine cells and dead viruses, preferrably in-viro. Let's hope that someone will manage to do it!

Well, it's a trade-off: we want private companies to invest billions of dollars to develop medicines we need, but they'll only do so if there's the potential for profit. If there isn't, capital will flow out of drug companies's R&D budgets and into car manufacturers or something.

Governments that want to make a new life-saving drug available to all, not just those who can afford it, are free to subsidize it. Citizens and governments in wealthy countries who want to make the drugs available to citizens of poor countries can likewise fund it.

It's easy to paint a company as horrible because it wants to charge a lot of money for a life-saving new treatment. But in many cases that treatment wouldn't exist if the company couldn't make money from it.

Well, it's a trade-off: we want private companies to invest billions of dollars to develop medicines we need.

The dependence on the private sector is the real problem here. Of course, pharmaceutical companies spend a lot of money on R&D and expect to make it back with the lucrative successes. However, this is not necessarily the best solution for society as a whole. Particularly in countries with a national health service funded by general taxation, paying lots of money to drugs companies is not an efficient use of resources. Directing the same money to universities to perform the research would ensure development of the same life-saving drugs while also ensuring that the drugs can be made available to all who need them.

No offense to university people, but universities are horribly inefficient places for real world type of work. Businesses are designed around efficiency. Ever heard "those who can't, teach"? It's true. Academia is good for theoretical work, but not for actually getting something done. Academics don't have any real incentive, and in jobs that are driven by tenure and seniority, you're inevitably going to have lots and lots of inefficiency.

As noted in the European Commission's recent Communication on an industrial policy for the pharmaceutical industry, the EUs share of "new chemical entities" (NCEs) developed worldwide has fallen from one half 20 years ago to only around one third today. Moreover, a McKinsey study has shown that Europe lags behind in major innovations. Of the NCEs developed in 1975-1989 categorized as "breakthroughs," as opposed to those representing merely "therapeutic progress," two-thirds originated in the laboratories of

This is simply not true. R&D costs are huge, between $500M and $700M depending on who you believe. Clinical trials alone cost a fortune and take years to conduct. The vast majority of drugs do not make it to market. Thus pharmaceuticals must make huge profits on the ones that do to make up for all the many ones that don't.

I wish it were that simple. Unfortunately, drug companies only spend a small amount on R&D - in "The Truth About Drug Companies", Dr. Marcia Angell discusses how on average drug companies spend 2.5 times as much on advertising as they do on R&D. Furthermore, 1/3 of the drugs being marketted by the major manufacturers were discovered by universities or small biotech firms, but are being sold at greatly inflated prices.

For example, Taxol was discovered by NIH, but has been sold by Bristol-Meyers Squibb for 20 times what it cost to produce, and NIH only gets 0.5% royalties. Most drugs that the drug industry itself develops are what she calls "me-too" drugs - drugs that perform the same function as an already extant drug on the market with little difference, and often are based on the same chemical formula with minor modifications. They need not be more effective than current formulations in order to be able to be sold - just more effective than a placebo.

The top 10 pharmaceutical companies make more money than the rest of the Fortune 500 combined. And not only are they granted a limited monopoly, but they often cheat. For example, Astra-Zeneca, when their exclusive rights to Prilosec expired, patented a combination of Prilosec and an antibiotic, and then sued a manufacturer of generic Prilosec because a doctor might proscribe it along with an antibiotic and thus infringe on their new patent.

on average drug companies spend 2.5 times as much on advertising as they do on R&D

Part of the advertising spending is dead weight, but not all of it. Advertising does have the effect of making potential customers aware that there are drugs that treat their conditions. How much benefit does a drug do if nobody knows about it? Before you say the doctors will tell their patients, remember that drug companies telling doctors about their drugs is still advertising, and remember that not everyone goes to a doctor over every ailment, especially if they mistakenly think there is no treatment.

1/3 of the drugs being marketted by the major manufacturers were discovered by universities or small biotech firms

Then I take it 2/3 of drugs being marketed by the major manufacturers were developed internally. And how did the manufacturers get the IP rights from the small biotech firms? If they bought the rights or pay royalties, then they are paying for the research that went into the drug plus the firm's profit. I doubt all small biotech firms are as dumb as the NIH was with Taxol.

Most drugs that the drug industry itself develops are what she calls "me-too" drugs

"Me-too" drugs limit the ability to abuse the limited monopoly by acting as competitors. That's a Good Thing. Or should everyone still be using Mosaic because all other browsers developed are "me-too" software?

They need not be more effective than current formulations in order to be able to be sold - just more effective than a placebo.

If a drug doesn't provide benefits in effeciveness, side effects, interactions, or price, most doctors won't prescribe it. Doctors do have easy access to reference material on all these factors, and part of what they're paid for is to know how to evaluate which drug is best for which patients.

The top 10 pharmaceutical companies make more money than the rest of the Fortune 500 combined.

Good. How much is a few more years of life worth to you? Or not being impotent? Or relief from chronic pain? And if it's not worth to you what people are paying, switch to an insurance plan that doesn't cover prescription drugs and opt out of the whole affair.

And not only are they granted a limited monopoly, but they often cheat.

This part is genuinely lame. IP law need fixing to limit these kinds of abuses.

I know plenty of people whose quality of life (an capability of staying alive) depends on the fact that, for instance, there are several different kinds of dopamine antagonists (prochlorperazine, metoclopramide, domperidone) used in gastroparesis, since they all have different effectiveness and different side effects in different people. I know people who might not be alive today if, for instance, a decision was made not to produce domperidone, but they just stuck

Erm. The same company that devloped Vioxx also devloped Ivermectin (Mectizan [merck.com]), a highly effective treatment plan (once every 12 months) for River blindness [wikipedia.org], a dehabilitating disease that affects people who can't afford modern medicine. Despite Merck dumping about $290 million into developing the treatment, they give it away for free.

Before you attack Merck with pitchforks and torches in hand, you ought to realise that this company has an unprecedented history of philanthropy, and it saddens me to know that somebody at that company with their eyes in profit instead of the Right Thing screwed up so royally with the debacle we know today as Vioxx.

Whatever happens with that company, I hope that at least some of their positive ideological foundations are continuted.

While I've no argument with the above posts, that's not a complete picture of Merck's behaviour:

Ivermectin is also used to prevent heartworm infections in dogs. When I did the math, here's what I found: sold in pill form, the only form available for dogs, the cost at wholesale to treat 30 medium-sized dogs for one year was $1500. The exact same quantity of drug, sold as an injectable/drench for sheep, cost $2.50 at retail (and that's about 4 times the price for the same drug as formulated for cattle). Despite numerous requests, Merck refused to make an injectable/drench formulated for dogs, even tho there is no reason not to (other than "got 'em by the balls, so squeeze hard"). The price is not so bad if you've only got one pet, but it's quite expensive if you've got a kennel.

Judging by the price for the most concentrated formulalation (for cattle), ivermectin is so cheap to produce that it might as well be free; most of the cost is evidently unavoidable overhead, like bottling and shipping. So don't get too excited about Merck giving it away to treat river blindness. It makes them look good (and it was the right thing to do) but it cost them damnear nothing.

Aside from that, when you RTFA you'll see that this isn't a regular drug, it's more of a therapy -- as I understand it, you use cells from the patient's own body and basically train them to combat the HIV virus. Unless you can create a generic version that would work across populations, it's not as simple as just shipping a bunch of shots off to the third world like we were able to do with polio.

As for "open source" drugs: You should realize it isn't that simple. It costs a lot of money to find, test and approve new drugs. While I'd agree that our current system enriches the drug companies at the expense of the little people (among a myriad of other problems), it's really important not to assume you can think of the industry like you do computing.

Like the parent said, it's a therapy, not a vaccine. It looks like it can help people who have been infected with HIV keep from developing AIDS, but it's not a cure and it won't prevent infection. Still, it's a welcome development.

The fact is, HIV is the most daunting disease we have ever faced. If it had hit even 50 years earlier we may very well have faced an epidemic on the order of the Black Death. It infects and kills stealthily, and evolves within our bodies faster than our immune systems can recognize it. If it hadn't hit the gay community so severely and specifically we might not have even been able to identify it, and it's only thanks to advanced sequencing and crystallography technology that we can study it in the necessary depth. But what is really sobering is this: HIV has infected tens of millions of people, living and mutating within their bodies for decades, and as far as we know no one has ever fought off an infection. The human immune system may very well be completely unable to handle HIV, and that means we may never see a traditional vaccine.

But we live in an age of rapid technological progress, and I do know of three promising possiblities that could actually prevent infection. None of them has yet been tested.

The first is another line of french vaccine work [pasteur.fr]. Sequence comparison between various strains of the virus had identified a highly conserved protein region on the GP41 surface protein. The antibodies produced against the peptide seems to target the virus extremely well in the lab. So why don't we see antibodies against this epitope in the real world? It turns out we sometimes do - but those people can still get sick. It may yet be useful but based on that simple fact I'm not holding my breath.

The second hasn't even had an in vitro experiment yet and technically doens't prevent infection, but is a highly unusual and novel approach. Researchers at Berkeley have come up with the idea of a virus that is a parasite of HIV itself. The trick is that the antivirus cannot push the level of HIV too low, or the antivirus itself will die out and latent HIV will come back, which they were able to demonstrate thanks to computer simulations of the population dynamics. However, it can mute HIV activity and thus prevent infection from developing into full-blown AIDS. What's more, if the carrier happens to spread AIDS to someone else, the antivirus will go with it, and when HIV mutates the antivirus can still affect it. HIV would become a virus that people could live with without it killing them. But there is no way to know whether or not something unforseen can happen with what is essentially genetic engineering, and at the very least moving that research from the computer to the real world will be a real task. There is a lot of work to be done there.

The third technology could be the real deal. The fact is, some lucky people are resistant to HIV infection. Their CCR5 receptors [projinf.org] are knocked out, and apparently HIV is unable to fuse with the cells as a result. Genetically altering your immune system to suppress this gene might thus offer protection against AIDS. However, that same mutation may be associated with multiple sclerosis [blackwell-synergy.com]. Again, nothing like this has ever been tried.

That's as far as I know, really. I regret that society and the government cynically ignored the epidemic when it was in far fewer people and might have been stopped with quarantine because it happened to affect a group that many people weren't fond of. I suspect now society may have to accept the inevitable and stop people from having multiple sexual partners. I fear the possiblity that HIV could mutate into something that can infect even without sexual contact in the meantime.

"I suspect now society may have to accept the inevitable and stop people from having multiple sexual partners. I fear the possiblity that HIV could mutate into something that can infect even without sexual contact in the meantime."

Your comment was interesting and well researched up until this point. Much of the HIV research done in high risk groups of individuals has revealed that polyamoury is very much a part of our human animal. The discovery of heterosexually identifying MSM's (men who have sex with men) is a particular point of interest. These men often covertly have sex with other men but are otherwise heterosexualy identifying. Most importantly is that these men consider themselves heterosexual and monogamous. They aren't "fags with aids", at least in their minds.

The idea of "enforcing" monogamy is a pretty chilly concept. Much of the AIDS epidemic in the developed world has it's roots in this societal stigma of it being the sexual deviant's disease. A virus kills indiscriminantly. As a culture we should choose to continue developing our responsible sexual civil liberties. It's only with openess and education that we will control this disease in the present. State enforcement of behaviour is socially retroactive and inconsequential. The choice to make love with whom we please is not a crime. It's a modern responsibiliy that we choose to take.

It's not so much society that would do the enforcing, it would be the disease. As in if you have sex with anyone who has had multiple partners you have a strong possiblity of catching the disease, and thus anyone who has multiple partners will instantly come under suspicion. Or worse, the uncautious people will just start dying and leaving the cautious people alive.

Keep in mind, the whole extramarital sex thing has only been socially acceptable for 40 years or so. Though it has been practiced for much l

The fact is, HIV [sic] is the most daunting disease we have ever faced.

While I don't intend to convert this into a my-disease-is-more-dangerous-than-yours competition:-), I don't think you've been in any affected region during last year's SARS crisis. I was, and boy was it scary; streets once lively even at 3AM, turned ghostly.

Which, of course, is not to deny that AIDS is daunting.

If it had hit even 50 years earlier we may very well have faced an epidemic on the order of the Black Death.

That's called innate immunity, and it has little to do with the immune system. Actually this is a form of evolution, which means that the necessary mutation must occur and be selected for before it has any chance of stifling the spread of the disease. And that process can take decades to hundreds of years [eurekalert.org].

In fact that innate immunity against HIV is already present in the form of ccr5delta32 individuals, mainly in caucasians and possibly as a result of the Black Death [bbc.co.uk]. There are other genotypes where ccr

If it's effective, it will be affordable, one way or another. If the maker sets the price too high and governments or aid agencies don't step up, the demand will be met by the generics makers, and governments will turn a blind eye as necessary. No amount of flak about "respecting IP" outweighs a quarter of your population dropping dead.

I wouldn't be surprised to see the Bill & Melinda Gates Foundation get involved here, too. Say what you like about Bill, the Foundation has done some good work in this field, and he's not short of the shekels.

The stuff might start off expensive, but eventually the process will be refined and more mass producable. A lot of processes start off like that: at first only the wealthy can afford it, then it becomes more common and mainstream.

The important thing is to get the initial process or idea out there in the first place. Then you can get people to work on it and refine it. But you need the right balance of: reward the inventors vs allow others to mass produce it.

Actually, the vaccine is being designed for use in countries where conventional therapy is simply much too expensive. It can be kept at temperatures up to 50 degrees (C) for up to 2 years - which, together with the fact that it seems to only work against the HIV-B strain (most common in Africa), seems to indicate that it is headed for sub-saharan Africa. One of the doctors following / contributing to this project gave a presentation on it at the Munich AIDS Days seminar last week. Although the stage one trials on people are showing some progress, the processing involved (own cells, own virus) still makes it kind of prohibitive - i heard that the time frame for wide-spread therapeutic use is 5-10 years.

The unfortunate fact is: it isn't a cure, but a management therapy which should allow infected people to live longer, more productive lives. Even worse - the pharma corps seem to be losing interest in designing new drugs - there hasn't been anything new for about 3 years now... No money in it, especially now that the UN and various charities are clamoring for reductions in trademark and other IP law restrictions. Good for HIV+ persons in poor countries, bad for the pharmacorps bottom line...

Haven't red the WebMD blurb, wasn't at the Munich AIDS Day, but I did read the article in Nature Medicine and I am an HIV researcher. First, HIV clade B is NOT most common in Africa, it is most common in North America / Western Europe. Clade C predominates in Southern Africa, while clade A predomiantes in East Africa. Though frankly, it doesn't matter much in this context. For this vaccine to work, the scientists extract the patient's own HIV (clade probably won't matter), inactivate the virus chemically, a

I tend to think that anyone who is infected with HIV is unfortunate. Or cancer. Or any other nasty disease.

"I got a feeling that only those wealthy people can afford to get fixed up"

Well, think of the wealthy as gamers who want the latest rig. They have the money, and are willing to shell out for the cure when it is new and relatively rare. When R&D costs are paid off, or manufacturing costs drop (they begin mass producing the cure), then the masses will join them.

Begging your pardon, sir, but I have HIV and I didn't get it through irresponsible action. I received the virus through an unfaithful wife, with whom I believed I was in a monogamous, long-term (10+ years) relationship.

I realize that your sheltered existence makes it easy for you to dismiss the majority of the millions who suffer from HIV as irresponsible, but I'm here to tell you, it's not always so, nor do I find that most cases (at least that I know of through the support groups) are caused by irresponsibility.

Just think about this before you dismiss "most" of HIV sufferers. I did not engage in dangerous activities. I was not an intravenous drug user. I did not engage in homosexual sex. I didn't apply medical care to an HIV patient without appropriate protection.

I had sex with my long-term partner. And now I'm left to die, knowing that I never stepped beyond what was "safe".

HIV is a terrible disease, and it can affect anyone. Chalking a majority of infections to irresponsibility is facile and dangerous. Nobody is safe from this terrible, terrible disease.

I realize that your sheltered existence makes it easy for you to dismiss the majority of the millions who suffer from HIV as irresponsible, but I'm here to tell you, it's not always so, nor do I find that most cases (at least that I know of through the support groups) are caused by irresponsibility.

If you assume that all heterosexual contact infections were 'responsible', and then add in blood transfusions, coagulation disorders and other 'responsible' actions, then you still end up accounting for under 20% of infections in the US. [avert.org]

HIV/AIDS is terrible, and I certianly don't want to discount the lives that are affected by it.

However, claiming that the majority of infections, at least in the US, are not preventable is far more dangerous than saying that "Chalking a majority of infections to irresponsibility is facile and dangerous."

The caveat 'at least in the US' applies because in other countries, especially the African nations, the culture of male dominance actually speeds the infection. A large percentage of those infected perhaps did not have the opportunity to act responsibly.

I understand how to protect my computer from virus and other attacks, and therefore I have not had an infection on any of my computers for over a decade.

I understand how to protect myself from sexually and body fluid transmitted diseases, and therefore I am not HIV/AIDS positive.

I don't claim that I am immune - far from it - but my chances are greatly reduced. Perhaps equal to your chances prior to your infection.

I claim that if everyone chose to avoid placing themselves in risky situations, whether it be visiting a warez site and catching a virus, or getting drunk at a party and sleeping with a stranger, then the incidence would be drastically reduced. If this was the case, then efforts could go into protecting 'innocent' sufferers of the disease who got it not by risky behavior, but through other's risky behavior.

What the parent is pointing out is that you are not only a minority being part of the 2% of Americans suffering with this disease, you are also a minority within the disease, being one of the few who got it without engaging in risky behavior.

I hope for a simple, cheap treatment and eventual cure for this virus and the disease that generally follows. Until then, I hope that people act responsibly - that is our current best, and only, effective defense.

I cannot possibly understand what you are going through, but I wish you the best of luck.

If half of your potential customers are dead or dying, you lose half your income. So, to make up for this, companies raise their prices to make up for what they think they'll lose, which prices them out of the reach of even more people, who will therefore die from lack of the necessary resources. This reduces profits further. To compensate, they raise prices further, and the dance goes on.

The logical thing is to lower the price on critical core medications, so that they're in the reach of most or all peop

Sorry, but that just isn't true. The truth is that identical drugs, made on identical lines, cost more in the US than they do in Canada. Why? Simple: the prices in Canada are negotiated by customers who have the time to study the actual costs of production, and who aren't desperately begging for the treatment right now. The result is drug prices which are genuinely negotiated between producer and consumer, rather that prices set by a producer with no feedback from a market.

That is to say, the lower prices in Canada are due to exactly what most opponents of socialized medicine claim to support: a working market with multiple, informed customers.

Actually drug prices in Canada are regulated by The Patented Medicines Price Review Board (PMPRB), which is a government agency that oversees the pharmaceutical industry. This agency negotiates the final price for prescription drugs with pharmaceutical companies.

thats not entirely true either. i happen to work in the canadaian pharmaceutical industry and i would say that the no 1 reason that Canadian drugs are cheaper is that US patents run longer than Canadian ones. So a medication like fosamax can have a generic in canada a few years before the US industry can start producing one.

I dont work in the legal department, but i believe Canadian drug patents are good for ~5 years and US patents are ~8 years. after that time, companies like novopharm and other generic producing companies, can start churning out generics. even the big brand name companies (ie pfizer) have generic producing lines. this is primarily for overseas markets. in fact, alot of drug companies will manufacture the same drugs, with different names and pill shape/size, based on whatever region they are marketing in. a good example of this is reactine/zyrtec. those two medicines are the EXACT same. in canada however, you dont need a perscription for it an its called reactine. the length-of-patent experation numbers might be off but alot of the lower cost can be put squarely on the messed up US patent system.

Countries like New Zeland and the UK also have similar patent laws.

I have also heard, that the comapnies in fact do price medication higher in the states because they feel that thats what the market will bare. I dont think that the grandparent was that far off from the truth.

but i believe Canadian drug patents are good for ~5 years and US patents are ~8 years

No, the patent durations are more like 15-20 years. A lot of that time is used up by clinical trials though.

after that time, companies like novopharm and other generic producing companies, can start churning out generics. even the big brand name companies (ie pfizer) have generic producing lines. this is primarily for overseas markets.

It's not primarily for overseas markets at all. It's purely a matter of if a pa

The number 1 reason Canada's medicines are cheaper is because of our government or healthcare system. The Canadian government buys them in bulk and controls prices.

Exactly the same in the UK. The NHS negotiates (note *negotiates* - the drug companies are not forced by law to participate) massive discounts this way based on a modest but reasonable profit for the drug companies. This saves us *billions* as a country. The drug companies charge whatever 'local conditions' allow and the US system allows them t

Simple: the prices in Canada are negotiated by customers who have the time to study the actual costs of production, and who aren't desperately begging for the treatment right now.

This is so completely false that it is not even funny. First off, price ceilings are affected in Canada by its Patented Medicine Prices Review Board. Second, drug distribution is controled by the provinces through each province's list of approved drugs, known as the provincial formulary. If you're not on the formulary, chances are you're not going to be sold in that province. The provicne then negotiates the prices of drugs on the formulary. This has allowed Ontario to freeze the prices on all formulary drugs since 1994. Customers do not negotiate the prices, the government does.

However, the biggest reason drugs are cheaper in Canada is because per capita income is about 20-30% lower in Canada than in the US and there are drug trade barriers between the two markets. If there were no barriers, then the prices would equalize across markets since one could buy a drug in Canada and sell it in the US. But with barriers, drug companies can easily set different prices in different markets, charging their richer customers (US) more than the poorer ones (Canada.) This is a classic monopolist tactic known as differential pricing. Ultimately it is the lower income caused by socialism in Canada and free trade barriers between the countries that cause such a large price disparity.

It's more general than that. Because we have middlemen (insurance companies) that sit between us and those paid to provide our health care, the cost of said care has been successfully divorced from our ability to pay. How much do you think your local mechanic would charge if your car insurance company paid the bill?

Everyone talks about Canada's "socialized medicine" being so different in principle than the United States', but really, when you think about it, that's exactly what an insurance company is supposed to be! It's a socialist concept from the beginning. Few can pay the actual cost of significant health care, so everyone pays into the kitty, and those in need take out. Not so different, in principle. The problem is the people in charge of that kitty. Note that both the middlemen and the health care providers in this country are profiteers, and that applies as much to state-run programs such as Medicare and Medicaid as it does to private organizations. The drug companies are one of the most public examples of medical profiteering, but there are many, many more. Actual health care is no longer the primary focus of the United States medical system. Like so much else in this country, the prime function of the medical system is to transfer wealth from one group to another (much smaller) group. Which is great, I suppose, if you're part of the latter group. I'm not, so I don't like it.

You would think that insurance companies would try to find ways to keep costs down by putting pressure on medical suppliers. But they don't. They don't have to. They simply keep their rates as high as the market will bear (and beyond) and then do their level best to disqualify anyone they can from actually receiving any care. And that was before HMOs came on the scene. The result has been yet another group of murderous corporations that are so flush with money, and complicit in the deaths of so many people, that they almost make the tobacco companies look angelic.

I think our philosophies are very different, but your observation is very true. Insurance companies ARE very similar to socialism.

The problem is that medical insurance became widespread when companies started offering health plans in lieu of pay.

Everyone has some basic levels of medical costs: vaccinations, pediatrician visits for their children, eye care, dental care, occasional medical situations (perhaps a broken bone or infection), etc. If you buy insurance against something that everyone knows will happen to you, then the only result is that the insurance company wins big time, just like Las Vegas: they know the numbers and they know that they will win.

What you buy insurance against are the high costs that you probably won't suffer, but would create a hardship if you did. These include tragic accidents that are rare but require hundreds of thousands of dollars to fix, or bizarre diseases or something.

What we have is a situation where basic medical needs are being covered by insurance, which means the customer is always losing (just like if you spend enough time at the blackjack table).

The only thing that makes sense is to drop the insurance policy that you lose out on, and get a cheaper policy that only covers the big stuff. Then pay the little stuff yourself.

Then you also benefit because your premiums aren't covering the costs of high-risk lifestyles of other people. The insurance companies can't discriminate and charge those people more, sometimes because the law won't let them (i.e. they can't charge more to gay people) and sometimes because they don't know (druggies or something).

Well... as currently operated I would say they are very similar to a seriously malfunctioning socialism. You do understand that I was talking about an ideal insurance company, or should I say, the principle of insurance. Insurance companies in the United States today have more in common with organized crime syndicates than they do with socialism. So while I'm pretty much a dyed-in-the-wool capitalist I wasn't actually making a negative comment about socialism.

But you're right about the odds. The only organizations that invest more in actuaries and statistical monitoring of their clientele than casinos are the insurance companies. Incredible, really. And, I guess, successful: the amount of money these companies rake in is truly phenomenal, and as health care delivery gets poorer and poorer they take in more and more.

Some years ago my girlfriend's father had to go in to the hospital for an MRI. No big deal, in and of itself, but after he was released and his wife was reviewing the hospital bills, she noticed that the insurance company was being billed for not one, but TWO MRI's, at the same time on the same day! Sure, it wasn't their money, exactly, but it did count against their liftime cap. And besides... it was wrong. She immediately called the insurance company's hotline to point this out. The answer was, "Well, we pretty much have to go with what the hospital tells us" and by God they paid it! I've had a number of similar experiences: these people just don't seem to care about overbilling and so forth. That leads me to believe one or both of two things. A. that they are so flush with money that they simply don't care or B. there's some conflict of interest going on between the management of the hospitals and that of the insurance companies.

My own father, some years ago, was in the hospital after a minor heart attack. He was only there for two days, and had some minor tests done (EKG, etc.) and a couple of X-rays and the rest was just for observation. The resulting bill was over thirty - thousand - dollars. The list of charges was almost an inch thick! Well, we decided to fight that one, and camped out in the outer office of the hospital's accounting department. After several hours going up the chain of command, we got to speak with a very, very nice woman who was the chief accountant. We explained that were disputing, well, pretty much almost all of the charges. She said, well, let's see what we can do. She went down the list, item by item, and asked "Did you see this doctor?" "No." "Did you have this test?" "No." It was MIND BOGGLING how many people and companies got some juice money stuck on his bill. By the time we were done it was less than five grand. An afternoon well spent, I'd say. But you can see why I have very little patience with the entire industry.

Read the rest of my message. Then read my followup. I'm hardly a proponent of the United States' health care delivery system. I was speaking in theoretical terms anyway.

Sorry, dude, but Canada's system also has some serious problems. What it comes down to is that, if you want to stay healthy... take care of yourself and try to avoid unnecessary contact with the medical system.

Generic drugs in the USA are almost as cheap as the generics in Canada. It's just that Americans don't trust generics, as they see them as inferior.

The generics in Canada are only produced after the patent expires, ie, 20 years. I don't know where you got the ridiculous idea that Canada doesn't respect US patents, but it's utterly ridiculous and ignorant. Next you'll be claiming Canadian drugs are unclean and manufactured with lacking production controls. Another myth perpetuated by the US pharmaceutical companies who see Canada undercutting their costs and stealing their mojo.

The cost is not directly subsidised by any tax dollars, sorry. No, just because we have socialized health care does not mean drugs do not have a price, it's just that most of that price is paid by the government for us. The drugs are still cheaper. There are several reasons why, and I've seen some of them discussed in this thread already.

The article you link to doesn't even mention Canada, Canadian laws, or the Canadian drug market. How exactly does this support your argument?

It's a FUD piece supporting drug patents. I liked this quote...Patent pirates, however, want to steal even more of a drug company's property. Their justification is the need for "humanitarian" aid. They offer the notion that it is unethical for companies such as GlaxoSmithKline, Roche and Pfizer to put their patents and profits above the suffering of those in Africa and other needy places who are afflicted with HIV, malaria, tuberculosis and other treatable diseases.

Eli Lilly and Co., the maker of Prozac, the most proscribed anti-depression drug on the market, has earned 10,213.6 Million USD in the past 9 months. The cost of those sales was 2,358.2 Million USD. Research and Development cost 1,975.6 Million USD.

Marketing and adminstrative cost 3,186.0 Million USD.

In other words, you're absolutely right. Other companies would probably show the same result.

What the bloody hell is it with you yanks(Only yanks would argue because they have the highest prices in the world!) and your disdain for collective bargining agreements?

Seriously. These aren't sports cars, they're drugs many people need to continue living. Drugs which don't fall under this category, such as Prozac and Viagra, cost more in Canada than they do in the US.

Look at this page. [www.cbc.ca] When allergy medication and breast cancer treatments are being sold for 1/3 the price here than in the states, and the

Patent laws in Canada and the United States are different, and as such the length of time the patent is valid may mean that a drug currently covered by a patent in the US would not be covered in Canada.

But that has absolutely NOTHING to do with why drugs are cheaper in Canada. Name Brand drugs are cheaper in Canada. In many cases by as much as 80%.

The Canadian government negotiates the rates for a number of drugs. They make a commitment to purchase a large quantity and the drug company agrees to the price.

By the way, you might want to check out drug prices around the world. Nowhere in the world does anyone pay the kind of prices that exist in the United States.

Counterfeit drugs, according to the FDA, is any drug supplied from any source which does not have EXACTLY the same packaging and EXACTLY the same markings on the drug as have been registered with the FDA. This is Regardless of whether the drug is from the same production line, but put into a different style of packaging by the same manufacturer.

A company can simply provide the Canadian government with different style packaging and then, when imported back into the United States it will be considered a counterfeit drug.

You may not like the socialist aspect to Canadian healthcare, but quality of the drugs is not an issue.

We have this in the U.S. too. This is how health insurance companies can afford to provide such cheap drug benefit plans (if your lucky enough to have insurance).

During the times in my life when I've had benefits (now is one of them, thank god), i've been amazed at the huge difference in cost for drugs. I can understand that doctors cost money, and without benefits, I'll pay them upwards of $100 a visit. I think it's bonkers that with insurance, I pay ~$15 a prescription, and without, I can pay $200+.

Two people have already poked holes in your claim, but I'll add a third hole by pointing out that a woman who contracts HIV from her husband after he acquires it from another woman is certainly a victim.

True. Before this goes into the market, I would expect that it would have to be made into a "kit" that either you or your doctor could use relatively easily. I have no clue how you'd go about doing that, though...

I'm confused about the terminology: If it was used on patients who
already had HIV, wouldn't that be a treatment rather than a vaccine?
Or does the way if works -- apparently reconfiguring the immune
system to recognize HIV -- technically qualify it as a vaccine since
that's basically how vaccines work?

I'd imagine that this sort of therapy could be useful against a whole
range of viruses since (as I understand) it operates by training the immune system
rather than crippling something specific to the virus the way that other
HIV treatments do. If that'd work for most viruses, maybe someday people will be
able to just update their own
virus definitions a few times a year -- of course, most of them probably
wouldn't bother and then call me for support when they open some damn.exe file
they got in their friggin' email and... Sorry, started drifting there for a second.

Of course, it's awfully early to get too excited given this is just
18 people in Brazil so far, and "incredible effect" might be a bit strong since
only 44% of the very small number of test patients are still showing the full
benefit after one year, but I suppose any good news in this sort
of scenario is, well, good news.

PS: Am I the only one who finds it darkly ironic that "The Sexecutioner" submitted
this story?

What is in the vaccine is not important. The difference between a treatment and a vaccine is that the treatment attacks and kills the pathogen, or just alleviates symptoms. A vaccine acts like the pathogen, causing an immune response that attacks and kills the pathogen, or a cellular response that stops the pathogen from being destructive.

Vaccines do not have to be made from live or dead specimens of the pathogen - they can also be made of specimens of a similar pathogen (smallpox vaccine is made from cowpox, for example), or anything that mimics a critical part of the pathogen closely enough to trigger an immune/cellular response.

People tend to think the difference is that vaccines PREVENT disease and treatments treat disease only because most people get vaccines before they have a chance to be exposed to a disease. If you somehow ended up with Polio or Smallpox or whatever, they'd still give you a vaccination to get your body to take care of it (and that's what they did back when they first created the vaccines).

Seriously, curing HIV is just dealing with a symptom of a problem. If the groups that promote AIDS and STD education in Africa could get just a tiny portion of the funding that goes into HIV medical research, the spread of AIDS would run into a wall. In South Africa, they have billboards [sympatico.ca] that say things like "You can catch AIDS by having sex with an infected woman." Americans think, well, no kidding, but very few people have bothered to tell the South Africans that. AIDS is a problem that has to be attacked on all fronts.

Actually, the AIDS education groups have more money at their disposal now than they are able to spend. Most of them have not been able to scale their operations as fast as the US government, WHO, and other governments and private groups have been increasing funds. They are also having problems coordinating all the different aid groups and governments to get treatment/education where it is needed.

The development of an AIDS vaccine is wonderful news for sure, but it is still not a cure at this point (it is only a treatment that keeps the disease at bay at this point). What's at least as important (if not more) is education as you have pointed out.

The problem is getting the third world (where the epidemic is most serious) to accept western medicine. Westerners think African-witch-doctor medicine is a bunch of bunk--well Africans have the same opinion of much of western medicine. Even if this vaccine WAS a cure, getting poor, illiterate Africans to accept treatment would require a lot of education and convincing (not to mention money that most of these victims do not have).

The most perverse myth in some African cultures is that STDs (including AIDS) can be cured in men by having unprotected sex with a virgin girl. I shudder when I think about how many HIV+ men there are in Africa who think they are cured because they have done this, but in fact may have infected some young woman and the child she might have conceived as a result--then in the mistaken belief that they are cure go on to infect other sexual partners. Somehow putting that myth to rest would do more to combat AIDS than the most expensive drugs currently available.

There is even a problem in the "educated" west too--it is that we are perhaps TOO educated (but in the wrong way). All this emphasis on advanced treatments for AIDS is making some people perceive the disease as no longer a death sentance but rather a chronic disease. The attitude when engaging in risky behaviour is becoming "Uh oh...I might have exposed myself to HIV...oh well, nowadays HIV is treatable like hepatitis and herpes--it would be a pain in the ass to have to treat it but I'll live alright anyways".

The homosexual communities of large metropolitan areas are already having to combat this attitude (having previosuly become the most educated/aware segment of society concerning AIDS) and if we aren't careful the rest of the public will start believing this too. In actual fact, even if a person could live a normal lifespan with HIV, delivering a vaccine cusomised for each recipient and treating symptoms with an expensive regimen of drugs would be another big burden on the healthcare system, not to mention that the quality of life would be permanently reduced even with todays treatments.

Yes, this is an important development, but without education and empasis on personal responsibility AIDS won't go the way of smallpox any time soon.

"The problem is getting the third world (where the epidemic is most serious) to accept western medicine."

I won't argue your central point, that people from under-developed nations often don't trust western medicine. You have to remember, though, that this judgement is largely based on experience. Hospitals in many parts of the world are where you go to die.

Health care is so thin on the ground in most nations that hospitals simply cannot afford provide the kind of care that North Americans take for grant

The only question is how well it'll work given the propensity for mutation that HIV has shown so far?

I may have misunderstood the process mentioned in the article, but it seems that they immunize you with cells from your own body. It's not a forumla your doctor will take down from his shelf and shoot you with. They take some of your blood, kill the HIV in it, load those dead cells into some of your own immune cells, and give that back to you. This wakes up the team somehow, if I've read it right. I don't

LOL... look at the FDA's wonderful load of crap lately.. how many drugs have been pulled that the FDA said was ok? give me a break... the FDA in my opinion has turned into a load of shit...

and to add to that look how the government was trying to stop people from getting their drugs from canada.. and yet when the flu vaccine had a shortage here who did they get more vaccine from? oh yes. canada.. who's drugs you can't trust...

Well the real cause for concern with the latest scandal with drugs and the FDA is a fundamental problem of pharmaceutical companies continually trying to reinvent the wheel by making new drugs to treat highly common cronic diseases with treatments that are just as effective already ( eg long term prevention of heart disease, athritis, obesity, depression, sleeping disorders), with often a "me to" approach of producing new drugs that work similary to drugs from another company (notice the explosion in erectile disfunction drugs after the introduction of viagra.

In the case of vioxx, the treatment was designed for anti-inflammatory pain relief in arthritis, by inhibiting an enzyme COX2. It is about as effective as another drug many of us have taken ibuprofen (Advil) for this purpose but instead of being 3-5 bucks for a bottle of 50 to 100 pills, it was sold at ~$2 a pill (it is also how aspirin works to relieve pain as, thus the running joke that the pharmaceutical companies had invented the $2 apirin).

So what was so much better about vioxx that it was developed, FDA approved and prescribed by doctors.

Well it doesn't inhibit another enzyme COX1, like aspirin and ibuprofen do. Inhibiting Cox1 has several effects, the two most important are: the negative effect, gastrointestinal problems like stomach bleeding and ulcers; but it also has a positive effect which is prevention of blood platelet aggregation which prevents blood clots, heart attacks and strokes. This is why aspirin is taken to prevent heart attack, if you take aspirin to prevent heart disease and a specific COX2 inhibitor for arthritis like vioxx together you are really losing the benefit vioxx had over ibuprofen.

Anyway not everyone has a sensitivity to asprin and Ibuprofen, there are estimate that only 8% of those prescribed Vioxx actually got a benefit over cheaper alternatives, but vioxx had a great ad campaign that convinced everybody that they should "ask" (read demand) their doctor to prescribe it, even though it is vastly more expensive. Also the FDA approval could be pushed through because of the "benefit" to those 8% of patients that had gastrointestinal sensitivity to aspirin and ibuprofen.

So what have they found out now- well just inhibiting COX2 by itself actually causes increased blood platelet aggregation and increased risk of heart disease and stroke, this effect is balanced out by the inhibition of COX1 in aspirin and ibuprofen etc. that prevents platelet aggregation.

Now the real issue, Vioxx was pushed out to compete with very cheap, safe and well charactised drugs (so we know all the side effects etc., why do you think you can buy them at the supermarket) due to a very long history of use. Patent it and get it approved for use by the FDA targeting it to one small specific group that have a problem with current treatments to help push the approval through. Once it is approved marketing it to a much wider group of people that are not the specific target group, and will not gain any benefit over a cheaper, better characterised and now known to be safer alternative. To compound the problem the TV advertising of prescription drugs now almost approaching saturation increases this problem by getting the public to demand drugs they don't need.

I always hear about vaccines involving "dead" virus material. But I thought viruses weren't alive in the first place; that they were essentially protien envelopes containing viral DNA or RNA. Can anyone explain?

a dead virus is one that is no longer infective. your description of a virus is accurate, in that they are protein shells around genetic material (most of them, at least, some have enzymes in there and/or different shells)

From what I gather reading the actual article abstract [nature.com], they're inactivating or killing them with a compound that breaks off small portions of the capsid (general idea abstracted here [aegis.com]), but leaves the majority of the capsid intact. The slightly damaged capsid is unable to initiate infection, giving the host time to mount a defense against the real thing.

THe real question is does its effect at combating the virus continue and improve? Dropping the viral load count dosn't mean much if it only works once and or dosn't ever wipe it out. Besides this sounds more like a treatment (which is more profitable) than a vaccine (which is what you get so you never get aids)

It's a vaccine because it "teaches" the immune system how to deal with HIV - at least to the extent of keeping it from getting worse, and in some percentage of cases, enough to drastically lower the viral load and rate of transmission.

But it's not a PREVENTIVE vaccine like most widespread vaccines, and it can't be mass-produced since it uses material from each patient and is custom-made for them.

It's still potentially a great leap in terms of treatment of HIV/AIDS, though.

ERR... have you actually looked at any statistics latly? The fastest growing segment of new HIV patients is straight young Women. The largest segment are straight people. Gays numerically are a small group and they have a high infection rate, but fewer people with aids. A dozen people a year die from being stuck by lightning. A couple hundred striaght non-black people die each year of aids. I think your a few orders of magnitude off.

If you don't get laid, then you have the same chance of getting aids as be

In Africa AIDS is epidemic in the heterosexual population. It is like this no where else in the world. A possible cause is African sexual practices which include more partners in general (I consider this theory to be unlikely), and another cause is less sanitary conditions and more disease (open sores and such) which make sexually contracted AIDS far more likely. It could also be genetic suceptibility or even different AIDS varients in Africa, but there seems to be no evidence for this.

Figure out that the heterosexual spread of AIDS is rapidly becoming true in the rest of the world, and you'll live longer...

Seriously, read the news articles that are coming out today. The spread of AIDS in the heterosexual population is not just an African thing. It may be more advanced in Africa, but it's coming to the rest of the world.

This isn't a generic vaccine that's created in mass and given to everyone. The 'vaccine' is generated using viruses and dendrites from the specific patient. So it has to be done for each person. It reduces viral loads, but doesn't eliminate the infection.

Still it sounds really promising, but there's a LOT of work that would need to be done before this got anywhere close to general use. Also the article doesn't say how complex/expensive the process is per person. It doesn't sound like it's third world friendly, at least at the moment.

While this study (Nature Medicine Advance On-line publications [nature.com] Subscription required) shows promise, it is only a preliminary trial that included 18 participants. Sixteen of the participants were female and two were male. The figure stated in the/. article, of a 90% total drop in viral load, is not quite accurate. The article states that the patients plasma viral load levels were decreased by 80% (median) over the first 112 days following immunization. It then goes on to say that a prolonged suppression of viral load (up to 1 year after inoculation) of 90% was seen in only 8 individuals.

From my analysis of the HIV RNA expression data from this paper, after 1 year, eight of the patients had viral loads reduced by 90% or better, two patients had their viral loads reduced between 80% and 90% six patients had viral loads that were reduced somewhere between 10% and 50% and two of the patients actually had an increase in plasma HIV RNA levels.

Great idea : it may be of use for patient with resistance to all known anti-retrovirals. But...

It is NOT a vaccine. It is NOT a cure. It's a temporary (at best) treatment. The title is highly misleading. And its far from practical. You need to isolate dendritic cells from an (infected) patient, which is costly, require specific equipment and isn't trivial (forget developing countries, which can't even afford AZT). Then you pulse these cells with killed HIV, which I assume should come from the patient (else soon the treatment will go ineffective due to mutations acquired by the virus) and you reinject the cells, which will go 'alert' the immune system that something is wrong. So mass scale treatment is out of question. Basically, you're only boosting the (ineffective) immune system against HIV-1. After a year, their treatment reduced viral load by 90% in 8 of 18 patients. 90% isn't a lot (anti-retroviral do a lot better than that), and they aren't even achieving 50% success after a year. I would imagine that after 2 or 3 years, the success rate is even lower. And the CD4 count is stable, not increasing to normal levels.

Note that this research is being done in brazil and france, and so I doubt it is being funded by the so-called "free market" (yeah, right) profits from American pharmaceutical companies. You know the ones, those that are ripping us off, and paying Rush Limbaugh to spread propaganda about how we Americans are carrying the rest of the world with our free market (yeah, right) healthcare system.

Oh, by the way, France has nationalized healthcare--anyone walks right in and gets healtcare without paying. Real good system. Oh, yeah, that's right. We Americans are subsidizing their healthcare by paying for all this research.

Hmm. So that's why this vaccine to beat AIDS is coming out of France and Brazil.....

The reason this work is coming out of Brazil is the same reason the spinal cord story earlier this week came out of Korea. Namely, ethics. The single greatest hindrance to scientific advancement in the US. In the US, it would be unethical to conduct this study, because you couldn't let a group of people go without HIV meds for a year. That would be unethical. It's the same way it's unethical to test experimental therapies on patients with terminal cancer. Since their disease is terminal, it can be argued that they are consenting out of desperation, and the researcher is therefore taking advantage of them.

In any case, dendritic cells were discovered in the US, HIV was discovered in the US, etc., so it can't be argued that the giant money machine of US science didn't contribute. It also can't be argued that the US does not lead the world in biomedical science. This is because we spend so much money on it that the best scientists from all over the world are concentrated here. However, I agree with you that this is not the same as the idiotic statement that we are subsidizing other nations' healthcare.

Actually, no, it was discovered in France. While the complete research was done between a French (Montaigner) and an American scientist (Gallo), the actual discovery of the virus (not disease, virus) was done at l'Institut Pasteur by Montaigner and his team.
L'Institut Pasteur is a french public organization, owned and funded by the french governement.

In a quick google I found this link http://cbs5.com/news/local/2004/04/20/HealthWatch: _HIV_Discovery,_20_Years_Later.html

It doesn't stop HIV infections, but it prevents them into evolving into full-blown AIDS and reduces the risk of infection. Which sounds pretty good too, of course.:-) However, I'm not sure it removes the symptoms from HIV [wikipedia.org].

It doesn't stop HIV infections, but it prevents them into evolving into full-blown AIDS

The study only lasted one year. That's not enough time to really say whether it will prevent AIDS symptoms. They could, in theory, get sick next year, or next week.

reduces the risk of infection

No it doesn't, since the vaccine must be manufactured from a victim's own blood, and HIV virus from their own blood. The way I'm reading the article, it seems the vaccine is made on a person-by-person basis and can't be used

The vaccine is made from a patient's own dendritic cells and HIV isolated from the patient's own blood.

"The results suggest that [these] vaccines could be a promising strategy for treating people with chronic HIV infection," Andrieu and colleagues write.

This approach requires that you already have the HIV infection. This does not protect you from infection. This is not a cure. This is a treatment. It isn't clear that this will prevent you from spreading the infection either. This MIGHT prolong your life expectancy or even improve the quality of your life.

Am I the only person who thinks that therapeutic treatments (like this one) designed to prolong the lives of epidemic disease carriers is actually a horrible idea in the long term? Looking at this from a purely survivability-of-the-human-race perspective, the idea of increasing the exposure of disease carriers to healthy populations is not so hot. Prevention/eduction is key, and a full cure would be fantastic, but an in-between solution just isn't good.

In the early 80s cats were dying off from an immune system destroying virus too. Yetr medicine was lucky enough discover a vaccine quickly. Its a routine pet service now. This encouraged early predictions of a quick vaccine for the human version. But no such luck.

From the article: The vaccine is made from a patient's own dendritic cells and HIV isolated from the patient's own blood.

Think about what that means. No mass production. A blood sample from each patient must be taken, processed, and the finished vaccine returned to that patient, without error. There is no generic serum.

Forget the patent flame-war for a minute. The production costs of this thing are prohibitive. The costs of this thing will look more like the costs of in virto fertilization procedures than they will look like a vaccine.

I'm sorry to say that this announcement is, as yet, a nice bit of research and nothing more.

Yes, it's a horrible thing to say. And I find it interesting that I've repeatedly heard people praise the population control potential of AIDS, but never the various strains of flu, or other diseases. Read into that what you will.

On one hand, we can claim that the West created a virus designed to kill Africans, but yet still somehow manages to kill millions in North America/Europe; not particularly effective from a genocide point of view.

Another, perhaps more practical point of view, is that sex education and safe-sex practices are far less common in Africa. The lack of knowledge about STD's and the absence of the rule of law in many parts of Africa would make a far more effective explanation.

If we take Ms. Maathai's explanation, then food must obviously also be a genetically engineered weapon, since millions more in Africa die from starvation than those in the West.

No, it does not. HIV has never been shown to be transmitted by mosquitoes, and it isn't even clear how a mosquito could transmit HIV.

If over 99% of the population is AIDS free then the likelhood of a mosquitoe carrying AIDS and picking on a new victim is extremely low. However if 50% of the population has AIDS then the likelihood is quite significant.

HIV isn't very contagious. So what you need is widespread education and then (in general - there'll be exceptions of course) the stupid ones will go kill themselves off. Who knows, the next few generations might even be smarter as a result (or have better self control over their sex drives - which isn't such a bad thing if you ask me). Heck it's probably unlikely the typical Slashdotter would contract HIV;).

I'm more worried about the next killer flu pandemic. Even if the typical slashdotter doesn't leave